Conduction disorders after perimembranous ventricular septal defect closure: continuous versus interrupted suturing techniques

OBJECTIVES The aim of this study was to investigate postoperative conduction disorder differences between continuous and interrupted suturing techniques for the closure of perimembranous outlet-type ventricular septal defects (VSDs) in both tetralogy of Fallot (ToF) and isolated VSD cases. METHODS Patients aged 4 years or younger who underwent VSD closure for ToF (n = 112) or isolated perimembranous outlet-type VSD (n = 73) from April 2010 to December 2018 at 3 centres were reviewed. Patients either received continuous suturing for ToF (C-ToF, n = 58) or isolated VSD (C-VSD, n = 50), or interrupted suturing for ToF (I-ToF, n = 54) or isolated VSD (I-VSD, n = 23). Cohorts did not differ in preoperative characteristics. Postoperative conduction disorder differences upon discharge and postoperative year 1 (POY1) were evaluated by electrocardiography. RESULTS The C-ToF group showed significantly shorter PQ intervals (124.0 vs 133.5 ms; P = 0.042 upon discharge, 125.3 vs 133.5 ms; P = 0.045 at POY1) and QRS durations (98.0 vs 106.2 ms; P = 0.031 upon discharge, 97.3 vs 102.5 ms; P = 0.040 at POY1) than the I-ToF group. Right bundle branch block incidence was significantly lower in the C-ToF versus I-ToF groups (56.8 vs 75.9; P = 0.045 upon discharge, 56.8 vs 75.9; P = 0.045 at POY1). Heart rates were significantly lower in the C-ToF versus I-ToF groups at POY1 (109.2 vs 119.3 bpm; P < 0.001). No parameters significantly differed between C-VSD and I-VSD groups. Multivariable analyses confirmed the group (C-ToF versus I-ToF) as a significant covariate in postoperative heart rate, PQ interval, QRS duration and right bundle branch block outcomes at POY1 (P = 0.013, 0.027, 0.013 and 0.014, respectively). CONCLUSIONS A continuous suturing technique for the closure of outlet-type VSD in ToF could reduce the incidence of postoperative right bundle branch block, shorten the PQ interval and lower heart rate. Subject collection 110, 138, 139.

Left Ventricular Myocardial Noncompaction with Advanced Atrioventricular Conduction Disorder and Ventricular Arrhythmias in a Young Patient: Role of MIB1 Gene

Left ventricular noncompaction (LVNC) is a structural abnormality of the left ventricle, usually described as an isolated condition, or sometimes associated with other structural cardiac diseases. LVNC is generally asymptomatic, although it may present conduction disorders, arrhythmias, and heart failure. Here, we present the case of a patient who came to our attention with a severe LVNC phenotype associated with advanced AV conduction disorder, and supraventricular and ventricular arrhythmias at young age, in which a novel MIB1, likely pathogenic, variation has been identified.

Lipid Emulsion Treatment in Tricyclic Antidepressant Poisoning in Children: An Observational Cohort Study

Tricyclic antidepressant (TCA) poisonings are among the most common childhood poisonings because of being cheap and readily available. In this manuscript, we aimed to share our experience with Intravenous lipid emulsions (ILE) treatment in addition to basic treatment steps and discussion of effectiveness of treatment in cases of poisoning caused by high-dose TCA intake. From the patients under 18 years of age who admitted to Pediatric Emergency Department due to drug intoxication between January 2014 and December 2019; those who had history of exposure to TCAs were included in our study. In conclusion of examination of six-year patient records, it was determined that there were a total of 619 intoxication cases and 108 (17.4%) of these were TCA poisoning. 21 (19.4%) patients who had hypotension, tachycardia and ECG changes which were refractory to all basic treatment steps were administered ILE. After ILE treatment, a marked improvement was observed in patients’ clinical and ECG findings, as well as vital signs. Early administration of ILE treatment in emergency departments for cases with hypotension, conduction disorder, dysrhythmia or widened QRS which are refractory to sodium bicarbonate is thought to prevent potential cardiovascular complications.

Predicting Ventricular Septal Rupture in ST-Elevation Myocardial Infarct in Low Resource Setting: a case series

Background: The mortality rate caused by myocardial infarct (MI) escalates in the presence of ventricular septal rupture (VSR). This article aimed to analyze clinical factors that might be valuable as predictors of VSR. Case Illustration: We found and presented six documented post-infarction VSR out of 1,613 MI cases between January 2015 to December 2019. Conclusion: Based on the analysis, clinicians should be aware of these factors as they were potential to be the predictors: advanced age, first MI, anterior location of the infarct, infranodal conduction disorder, no reperfusion treatment, high systolic blood pressure on admission, and no smoking history.

Anaesthetic challenges in a patient with Wolff-Parkinson-White (WPW) syndrome for orchidectomy

Wolff-Parkinson-White (WPW) syndrome is an extremely rare congenital cardiac conduction disorder. It is due to an aberrant pathway between the atrium and ventricle. This manuscript entails a man with an underlying WPW who was posted for an elective orchidectomy. We discussed the important perioperative precautions to prevent the precipitation of acute cardiac events.

Examination and management of patient with accelerated idioventricular rhythm

The results of examination and treatment of a patient with a combination of accelerated idioventricular rhythm and atrial conduction disorder, which made it difficult to interpret the Holter monitoring data, are presented.